Organization
FARWEST DENTAL GROUP, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HASSAN FAYOUMI DDS (CEO)
(310) 699-1549
Entity
Organization
Contact information
Practice address
1704 N AVALON BLVD, WILMINGTON, CA 90744-1433
(310) 835-5030
(310) 835-6090
Mailing address
1704 N AVALON BLVD, WILMINGTON, CA 90744-1433
(310) 835-5030
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
50718
CA
261QD0000X
Dental Clinic/Center
Primary
52604
CA
Other
Enumeration date
08/21/2018
Last updated
08/21/2018
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